Patient management system

ABSTRACT

Embodiments of the present invention provide a system in which a medical device selects less than all of its stored information and provides the selected subset of information to a data mart for storage, processing, and/or communication to one or more interested parties. In many embodiments, customers, patients, or even components of the medical device or of the remote patient management system can access selected medical device information (e.g., customers can access medical device information tailored to the care they are providing to one or more patients). In many embodiments, customers can receive such medical device information according to a schedule that best suits their care (or whenever they desire such information, irrespective of a schedule). In many embodiments, providing less than full transmissions to the data mart reduces the strain on medical device batteries.

BACKGROUND

Some embodiments disclosed herein relate to patient management systemsand, more particularly, to patient management systems for controllingthe type and/or quantity of information communicated between a medicaldevice, a data mart, one or more customers, and/or the patient.

Medical devices are being offered with increasing capacity for storingphysiological and device performance data. Moreover, the use of homemonitoring instrumentation and equipment is gaining popularity formanaging patients with chronic illnesses. Physiological sensors formonitoring various patient conditions may operate in connection with amedical device and home based instrumentation for acquiring continuousor periodic physiological data for processing and/or storage by themedical device or for clinical management. Such data may be used by themedical device in automated therapy delivery or by a clinician indiagnosing or monitoring a patient condition and in his or her therapymanagement.

A data mart is a convenient place for storing physiological and deviceperformance data from multiple medical devices. Some data marts canstore data from tens of thousands of medical devices. Medical devicestypically provide all of the information stored in their memory to thedata mart on a periodic basis (e.g., every 90 days). Upon receipt of afull transmission from a medical device, the data mart usually providesall of that information to one or more customers (e.g., physicians,nurses, technicians, physician's assistants, etc.) charged with caringfor the patient having the medical device.

Providing such a large volume of information to customer(s) for eachpatient can pose challenges. In some instances, medical devices collectupwards of 4000 parameters related to patient physiology and deviceperformance. Customers often spend significant amounts of time andenergy sorting through the information to get what they need to care forthe patient. They could otherwise be spending this time and energyproviding enhanced care for their patients. Moreover, full transmissionscan put significant strain on medical device batteries.

In many cases, different customers may desire different information atdifferent intervals in caring for the same patient. For example, anelectrophysiologist is generally interested in reviewing certaininformation related to a pacemaker or ICD patient once every three tosix months, as long as the patient is not experiencing adverse symptoms.Customers other than electrophysiologists are often interested inreviewing different information related to the same pacemaker or ICDpatients at different intervals. For example, a heart failure specialistmay desire different information on a more frequent basis. A heartfailure specialist is often interested in looking at the clinical trendsin the device diagnostics in order to better manage the heart failure.The frequency of data review depends on the condition of the patient.Immediately after a decompensation (heart failure episode where lungsget fluid accumulation), the physician may want to review the devicediagnostic data on a daily basis for 1 or 2 weeks after the event butonce the patient has stabilized may want to only review these data oncea month or once a quarter.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings are illustrative of particular embodiments of thepresent invention and therefore do not limit the scope of the invention.The drawings are not to scale (unless so stated) and are intended foruse in conjunction with the explanations in the following detaileddescription. Embodiments of the present invention will hereinafter bedescribed in conjunction with the appended drawings, wherein likenumerals denote like elements.

FIG. 1 is a schematic block diagram of an illustrative remote patientmanagement system.

FIG. 2 is a flow chart of a method of remotely caring for a patienthaving a medical device, the method involving providing less than allinformation stored in a medical device to a data mart.

FIGS. 3A-3B are a more detailed flow chart of an illustrative method ofremotely caring for a patient having a medical device, the methodinvolving managing a limited data set at a data mart.

DETAILED DESCRIPTION

The following detailed description is illustrative in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description providespractical illustrations for implementing exemplary embodiments of thepresent invention. Examples of constructions, materials, dimensions, andmanufacturing processes are provided for selected elements, and allother elements employ that which is known to those of skill in the fieldof the invention. Those skilled in the art will recognize that many ofthe examples provided have suitable alternatives that can be utilized.

Embodiments of the present invention provide a system in which themedical device selects less than all of its stored information andprovides the selected subset of information to a data mart for storage,processing, and/or communication to one or more interested parties. Insome embodiments, such systems include various equipment, as discussedelsewhere herein, performing methods for remotely caring for patientshaving medical devices. In many embodiments, each interrogation cantrigger the transmission of only a tailored set of information.

FIG. 1 shows an illustrative remote patient management system 100. Theremote patient management system 100 forms part of a system used forremotely managing patients prescribed with medical monitoring or therapydelivery devices. The remote patient management system 100 allowscustomers to monitor and treat multiple patients located at multiplelocations. The illustrative remote patient management system 100 of FIG.1 shows three locations—Location A, Location B, and Location C. Remotepatient management systems are not, however, limited to three locations.Locations A, B, and C can represent, e.g., the residences of threepatients. Some embodiments of the remote patient management system 100allow customers to access data from patients' medical devices withoutthose patients having to visit a clinical facility. The remote patientmanagement system 200 saves valuable time—both for the participatingcustomers and for the patients.

Many different kinds of customers interact with the illustrative remotepatient management system 100. Such customers include physicians such ashematologists, electrophysiologists, interventional cardiologists,neurologists, endocrinologists, heart failure specialists, and others.FIG. 1 shows two illustrative customers-Customer X and Customer Y.Remote patient management systems are not, however, limited to twocustomers. Multiple customers can monitor and treat the same patient.For example, both Customer X and Customer Y can monitor the patientslocated at Location A, Location B, and/or Location C. Both Customer Xand Customer Y can have a computer for communicating electronically withother components of the illustrative remote patient management system100.

The illustrative remote patient management system 100 includes a datamart 105, which can be located at a central location. The data mart 105includes a central communication module 107, which allows the data mart105 to communicate with other components. The central communicationmodule 107 enables the data mart 105 to receive data transmissions frommultiple remote medical devices for enabling remote patient managementof a population of patients. The central communication module 107enables the data mart 105 to provide information, such as instructions,to medical devices at multiple locations. The data mart 105 interactswith various types of equipment at each location through a network 110.The network 110 can be a local area network (LAN), a wide area network(WAN), or other suitable telecommunications network, including theInternet. The data mart 105 includes a processor 108 that operates withan associated central database 109. The central database 109 may storepatient data and/or programs and algorithms used by the processor inperforming patient management operations (e.g., programming and/orinterrogating medical devices). The central database 109 can includeelectronic medical records in a relational database and can include datafiles and code used for controlling communication with externalcomponents.

An implantable medical device (“IMD”) 115, 120, 125 (implanted inside ofa patient) and an external medical device (“EMD”) 130, 135, 140 arelocated remotely at each of Locations A, B, and C of the illustrativeremote patient management system 100. The IMD 115, 120, 125 can be acardiac stimulation device (e.g., a pacemaker),cardioverter/defibrillator (ICD), a cardiac monitor, a hemodynamicmonitor, a neuromuscular stimulator, a drug delivery device, a glucosemonitor, or other IMD. The IMD 115, 120, 125 at one location can be thesame as or different than the IMD 115, 120, 125 at the other locations.The EMD 130, 135, 140 can be a remote home monitor, programmer, or otherEMD. The EMD 130, 135, 140 collects various physiological indicatorsfrom IMD patients, such as weight, systemic blood pressure, symptoms,and others. The EMD 130, 135, 140 at one location can be the same ordifferent than the EMD 130, 135, 140 at the other locations. The IMD115, 120, 125 and/or the EMD 130, 135, 140 can include some or all ofthe programmable options that are resident in the data mart 105 (e.g.,as add-on external algorithms).

The illustrative remote patient management system 100 of FIG. 1 includesa computer 150. In some embodiments, the computer 150 is located in thesame location as the data mart 105. In some embodiments, the computer150 is located remotely from data mart 105. The computer 150 can be adevice, or multiple devices working together, that accepts information(in the form of digitalized data) and manipulates it for some resultbased on a program or sequence of instructions on how the data is to beprocessed. In some embodiments, the computer 150 may include storage forstoring data for some necessary duration.

The data mart 105, the network 110, the IMD 115, 120, 125, the EMD 130,135, 140, and the computer 150 can be configured to communicate in avariety of ways. In one example, the IMD 115, 120, 125 is configured tocommunicate with the EMD 130, 135, 140, which is configured tocommunicate with the data mart 105 via the network 110. In someembodiments, the IMD 115, 120, 125 is configured to communicate with thedata mart 105 directly through the network 110. In some embodiments, thedata mart 105 communicates directly with either the IMD 115, 120, 125 orthe EMD 130, 135, 140 without use of the network 110. Communicationbetween the data mart 105, the network 110, the IMD 115, 120, 125, theEMD 130, 135, 140, and/or the computer 150 can be, for example,bi-directional. The communication configuration can be the same ordifferent with respect to Locations A, B, and C. For example, in someembodiments, the data mart 105 can be configured to communicate withLocation B's IMD 120 through the network 110 while being configured tocommunicate with Location C's IMD 125 through the EMD 140 without theuse of the network 110. Each communication among the data mart 105, thenetwork 110, the IMD 115, 120, 125, the EMD 130, 135, 140, and thecomputer 150 can be initiated by the recipient of the communication(“pull”) or by the transmitter (“push”).

The content of the information being communicated between the data mart105, the EMD 130, 135, 140, the IMD 115, 120, 125, and the computer 150varies according to the particular application. In some applications,the IMD 115, 120, 125 provides data to the data mart 105. The IMD 115,120, 125 can gather and/or store such data on a continuous or periodicbasis. In some embodiments, the IMD 115, 120, 125 communicates some orall of that data to either the EMD 130, 135, 140 or the data mart 105.The EMD 130, 135, 140, for example, communicates some or all of the datareceived from the IMD 115, 120, 125 to the data mart 105. In someembodiments, the EMD 130, 135, 140 performs one or more processingoperations on the data received from the IMD 115, 120, 125.

In some embodiments, the data mart 105 provides information to the IMD115, 120, 125 and/or to the EMD 130, 135, 140. In one example, CustomerX enters instructions related to, e.g., therapy, operating parameters,transfer code, or other instructions, into the data mart 105. The datamart 105 communicates those instructions to the IMD 115, 120, 125 and/orthe EMD 130, 135, 140, either through the network 110 or directly. Inone example, the patient at Location C requests information related to,e.g., a recently experienced symptom, from the data mart 105. Thepatient can make the request, e.g., via his/her EMD 125 through thenetwork 110. In response, the data mart 105 can communicate therequested information to the EMD 125 to be displayed to the patient.

In some embodiments, the IMD 115, 120, 125 can gather and/or storeinformation related to parameters such as device performance and variousphysiological indicators of a patient (e.g., heart rhythm, bloodpressure, respiration, patient activity level, heart wall motion, bloodchemistry, and the like). In some embodiments, roughly 4000 parametersare provided by the IMD 115, 120, 125 to the data mart 105. Examples ofkinds of parameters include pacing parameters, therapy settings,diagnostic data, stored digitized episode data, counter data, and timestamps for various data information, and other relevant parameters.

In some embodiments, all of the information gathered and/or stored inthe IMD can be provided to the data mart 105. Such a full transmissionof data from the IMD 115, 120, 125 to the data mart 105 can occur on aperiodic basis, according to a pre-selected schedule. For example, afull transmission can occur every 90 days. The data mart 105 can indexdata received from the IMD 115, 120, 125 according to patient,transmission date, IMD serial number, and/or any other factor that wouldaid in being able to access the data at a later date.

In many cases, the customer can access historical data in remotelycaring for patients. For example, the patient at Location C can providea full transmission related to IMD 125 to the data mart 105 on atransmission date, and the data mart can provide that information toCustomer Y. If Customer Y then detected a potentially noteworthy, e.g.,blood pressure level in the patient at Location C, Customer Y couldretrieve information from the data mart 105 that had been transmitted bythe patient at Location C to the data mart 105 at a previous date (e.g.,90 days earlier). Customer Y could then compare the patient's bloodpressure on the transmission date with his/her blood pressure on theprevious date before determining whether something should be done.

In some preferred embodiments, the IMD 115, 120, 125 can provide lessthan all of the information gathered and/or stored in the IMD 115, 120,125 to the data mart 105. In some embodiments of the present invention,the IMD 115, 120, 125, the EMD 130, 135, 140, the computer 150, theprocessor 108 of the data mart 105, and/or a computer at one of thecustomer sites can have access to a computer-readable medium programmedwith instructions for causing a programmable processor to perform one ormore methods. FIG. 2 shows an illustrative method of remotely caring fora patient having a medical device. As can be seen, the method caninvolve providing less than all information stored in a medical deviceto a data mart. The method of FIG. 2 can provide one or more of theadvantages discussed elsewhere herein (e.g., tailoring information tospecific requests, preserving IMD batteries, etc.).

In the method of FIG. 2, an instruction calling for medical deviceinformation can be received, and the instruction's origin and contentcan be determined. As shown, an instruction can be received by themedical device calling for medical device information (205). The medicaldevice can receive many kinds of instructions. For example, the medicaldevice can have recently identified and addressed a patient episode(e.g., ventricular tachycardia, ventricular fibrillation, arrhythmia,etc.), and the instruction can call for medical device informationrelated to that patient episode. That medical device information canthen be assessed to verify that the medical device is functioningproperly.

In another example of an instruction that can be received by the medicaldevice, when a component of the medical device detects that availablestorage in the medical device has fallen below a threshold level, theinstruction can call for information stored since a previoustransmission (e.g., all information occurring since the previoustransmission, only such information that is related to any patientepisode(s), etc.). Absent this feature, when a medical device transmitsinformation on a periodic basis, the medical device storage can fill upbefore the next scheduled transmission, resulting in overwritingpreviously stored (and perhaps not yet transmitted) medical deviceinformation. Customers often desire all such information for optimumpatient care. Additionally, the medical device storage is more likely tofill up during an unexplained “storm” of patient episodes or when apatient transitions from moderate risk to high risk, for example. Oftencustomers are especially interested in medical device information fromthese periods and are thus especially interested in preventing it frombeing overwritten. In some embodiments, one or more components of themedical device can detect when a variable is at, or has fallen below orrisen above, a predetermined threshold, and can provide an instructionseeking pertinent medical device information.

Another example of an instruction that can be received by the medicaldevice is an instruction relating to a device performance issue. Forexample, if a component of the medical device determines that a lead hasworn to a threshold level or that the medical device's battery hasdepleted below a threshold level, the component of the medical devicecan provide an instruction to the medical device calling for medicaldevice information related to the device performance issue. This canassist in verifying and addressing the device performance issue in atimely fashion.

As is mentioned above, in some instances, the instruction can beprovided from outside of the medical device, such as by a customer. Insome instances, the instruction can be received from a customer and cancall for information requested by the customer. In some such instances,the instruction is received according to a regular schedule and callsfor information that both (a) has been collected by the medical devicesince a previous transmission to the customer and (b) is related to carebeing provided by the customer. This can allow different customers(e.g., electrophysiologists vs. heart failure specialists) to gettailored information at tailored intervals, thereby allowing suchcustomers to focus on the medical device information that is mostimportant to their care of the patient. This can also allow a givencustomer to pick up a patient's file, realize that he/she would like toreview certain medical device information, and retrieve that medicaldevice information with relative ease.

In some instances, the instruction can be received from a patient. Aspatients get more involved in managing their own care, they may desireto access medical device information. For example, if a patient isexperiencing, or has recently experienced, a symptom (e.g., shortness ofbreath), he or she may want to review medical information. He or she canprovide an instruction to the medical device (e.g., through a menu on anEMD) calling for information related to that symptom or informationstored within a certain period of time (e.g., the past 24 hours). Inthis way, patients can access medical device information that wascollected by the medical device during a specific time period and/orrelated to a specific subject matter.

In some instances, the instruction can be provided by a component of theremote patient management system. For example, one or more components ofthe system can request information from the medical device in order toperform a medical test. In another example, one or more components ofthe system can request information from the medical device in order toperform a system integrity test.

When the medical device receives an instruction calling for medicaldevice information (205), the medical device can then determine theorigin and content of the instruction. In determining the origin of theinstruction (210), the medical device can determine whether theinstruction is received from a component of the medical device, from acustomer, from a component of the remote patient management system, orfrom a patient (210). As is discussed above, instructions can call formedical device information that was collected by the medical deviceduring a specific time period and/or is related to a specific subjectmatter. Thus, the medical device can determine whether the informationcalled for by the instruction is limited by time, subject matter, orboth (215).

As shown, a limited data set can be selected based on the instructionreceived (220). The medical device can select the limited data set frommedical device information stored in the medical device. In manyembodiments, the medical device can search through its large volume ofstored information and identify and compile only the medical deviceinformation that is responsive to the instruction.

Once selected, the limited data set can be provided to the data mart(225) (e.g., directly or indirectly through a network). In most cases,the data mart manages the limited data set based on the correspondinginstruction. The data mart can determine whether it has informationrelated to the instruction (230). If it does, the medical device cansimply prepare to receive the next communication (240) (e.g., a newinstruction, one or more of the communications from the data martdiscussed below, etc.). If the data mart does not have instructioninformation, the medical device can provide such instruction informationto the data mart (235) and then prepare to receive the nextcommunication (240). With the limited data set and the instructioninformation at the data mart, the limited data set can be managed (245).

The limited data set and the corresponding instruction information cancome in a variety of forms. For example, the limited data set caninclude medical device information related to a particular patientepisode, and the instruction information can be a request to the datamart to determine whether the patient episode was correctly identified.In another example, the limited data set can include medical deviceinformation stored since a previous transmission to the data mart, andthe instruction information can be an explanation that the availablestorage in the medical device has fallen below a threshold level, alongwith a request to store the limited data set with the patient's file. Inanother example, the limited data set can include medical deviceinformation related to a device performance issue, and the instructioninformation can be a request asking the data mart to investigate thedevice performance issue further. In another example, the limited dataset can include the medical device information requested by a customeror patient, and the instruction information can be a request asking thedata mart to create a report explaining what the data is. Several otherexamples are possible.

FIGS. 3A-3B provide illustrations for some of the ways in which thelimited data set can be managed at the data mart according to theinstruction information. As mentioned above, and as shown in FIG. 3A,the data mart can receive the limited data set, with or withoutinstruction information (405). Some embodiments involve forming anassessment of the limited data set (410) (e.g., at the data mart or at aseparate computer). In such embodiments, an algorithm can be retrievedfrom the data mart (415). For example, in embodiments in which the datamart is asked to verify that the medical device properly identified apatient episode, the data mart can retrieve an algorithm for determiningwhether the patient indeed experienced that patient episode based on thelimited data set. The same would hold true for embodiments in which thedata mart is asked to monitor device performance. Forming an assessmentof a limited data set, as opposed to a full transmission, posessignificantly less stress to the data mart. If no assessment is to beformed, the data mart can proceed to the method illustrated in FIG. 3B.

Referring again to FIG. 3A, in some embodiments, the algorithm calls forhistorical information related to the patient and/or the medical devicein addition to the limited data set (420). As is discussed above, thedata mart can store large volumes of information from a wide variety ofpatients. In some cases, the data mart may be able to provide animproved assessment of the limited data set by taking into account suchhistorical information as previously gathered medical device informationfrom the patient, information related to other patients who have similarcharacteristics or similar medical devices, and so on. Taking historicalinformation into account can identify the presence or absence of one ormore trends, which can provide significant benefit to customers in theircare for the patients. Accordingly, in many embodiments, historicalinformation can be retrieved from the data mart (430), and the algorithmcan be applied to the limited data set and the historical information toform an assessment (435). If the algorithm does not call for historicalinformation, the algorithm can be applied to the limited data set toform an assessment (425).

In some cases in which the data mart forms an assessment of the limiteddata set, the sensitivity of various sensors in the medical device canbe increased, resulting in more frequent assessments by the data mart.The medical device can make a very preliminary determination of a deviceor patient condition, and the data mart can perform the analysis tofunnel down to a more detailed assessment. While this may result in asignificant number of occasions in which the medical device'spreliminary determination is incorrect, it substantially reduces thelikelihood of an actual device or patient condition going untreated.Moreover, because most of the analysis is being performed at the datamart rather than the medical device, the impact on the medical device'sbattery is minimal. In cases such as these, the customer can be notified(e.g., remotely) and/or the patient can be notified (e.g., through alerttones) if there is an actual patient or device condition, and he/she canbe undisturbed if there is not.

For example, in some cases, a medical device is configured to monitorthree criteria as being indicative of lead failure. In such cases, themedical device commonly provides a full transmission to the data martwhen the medical device determines that two of the three lead failurecriteria are present. With systems as described above, however, thisfunctionality can be enhanced. The medical device can provide medicaldevice information related to those three criteria to the data mart whenthe medical device determines that even one of the three criteria arepresent. The data mart can then perform a more thorough analysis todetermine whether there are any lead failure issues. Thus, the medicaldevice can provide smaller amounts of more focused medical deviceinformation to the data mart on a more frequent basis with less strainon the medical device battery.

Once an assessment of the limited data set is made, some embodimentsprovide that the assessment can be investigated in greater detail (440).For example, the instruction can ask the data mart to assess whether aparticular condition merits further investigation. If the data martdetermines that the condition does indeed merit further investigation,the data mart can proceed with that investigation. If the assessment isnot investigated in greater detail, the data mart can proceed to themethod illustrated in FIG. 3B.

Referring again to FIG. 3A, the further investigation can take a varietyof forms. In some embodiments, the investigation can involve sendingverification software to the medical device (445), and verificationinformation can be received at the data mart based on the verificationsoftware (450). In many embodiments, the verification software canperform a clinical test on a patient. For example, a customer candetermine, based on the medical device information he/she has reviewed,that a patient may have sleep apnea. The customer can then prescribe asleep apnea test to verify his/her initial determination. The softwareto run the test can be downloaded to the patient's device, and theresults can then be uploaded back to the data mart and reported to thecustomer. Such an investigation often comes into play in the context ofa possible device performance issue. The assessment can then beinvestigated in greater detail based on the verification information(455).

In many embodiments, further investigation of the limited data set caninvolve retrieving a full transmission from the medical device (460). Insome such embodiments, a full transmission can be retrieved from themedical device (465), and the assessment can then be investigated ingreater detail based on the full transmission (470). Having the datamart form an assessment based on the limited data set before initiatinga full transmission can significantly reduce the number of fulltransmissions, thereby leading to several of the advantages discussedelsewhere herein.

In several embodiments, further investigation of the limited data setcan involve both sending verification software and retrieving a fulltransmission. For example, the data mart can initiate sendingverification software or retrieving a full transmission first and then,depending on the information received, initiate the other second. Inanother example, the timing of the verification software and the fulltransmission can overlap.

In some embodiments, information can be communicated to one or morecustomers (475). In such embodiments, the data mart communicatesinformation to the customer(s) (480). In some such embodiments, theinformation communicated to the customer(s) is based on an assessmentmade (and, in some cases, investigated in greater detail). In some suchembodiments, the information includes some or all of the limited dataset. In some such embodiments, some or all of the limited data set istransmitted from the data mart to a customer without performing anyanalysis on the limited data set. In the event that only a portion ofthe limited data set is transmitted to the customer, that portion can beselected according to a specific request by a customer or according to apre-selected program.

In some embodiments, information can be communicated to one or morepatients. As is discussed elsewhere herein, a patient can requestcertain medical device information. When the medical device has providedthat information to the data mart, the data mart can provide it to thepatient. In some embodiments, the data mart can provide an alert (e.g.,triggering an audible signal) to the patient through the medical device(either an IMD or an EMD or both).

In some embodiments, modification instructions can be transmitted to themedical device (485). In such embodiments, the data mart transmitsmodification instructions to the medical device (490). In many suchembodiments, the modification instructions call for modification of (i)how the medical device monitors for and/or treats conditions, (ii) howthe medical device stores medical device information, and/or (iii) thetime intervals at which the medical device transmits medical deviceinformation to the data mart. At the end of the process illustrated inFIGS. 3A-3B, the data mart can prepare to receive new information from amedical device (499).

In the foregoing detailed description, the invention has been describedwith reference to specific embodiments. However, it may be appreciatedthat various modifications and changes can be made without departingfrom the scope of the invention as set forth in the appended claims.Thus, some of the features of preferred embodiments described herein arenot necessarily included in preferred embodiments of the invention whichare intended for alternative uses.

1. A method of remotely caring for a patient having a medical device, the method comprising: providing, by a processor, an instruction to a medical device, the instruction calling for medical device information that the instruction limits by at least one of: being collected by the medical device during a specific time period; or being related to a specific subject matter; selecting a limited data set consisting of only medical device information that is responsive to the instruction, from medical device information stored in the medical device, the limited data set comprising at least one of: information collected during the specific time period or information related to the specific subject matter as called for by the instruction; transmitting the limited data set from the medical device to a data mart; determining whether the data mart has access to instruction information that indicates how the instruction limits the medical device information selected and transmitted by the medical device; providing the instruction information from the medical device to the data mart in response to the data mart determining it does not have access to the instruction information; and managing the limited data set at the data mart according to the instruction information, wherein managing the limited data set at the data mart includes analyzing the limited data set based on historical information stored at the data mart.
 2. The method of claim 1, wherein the instruction is provided to the medical device by a component of the medical device.
 3. The method of claim 1, wherein the instruction is provided to the medical device from outside of the medical device.
 4. The method of claim 1, wherein managing the limited data set includes (i) retrieving an algorithm from the data mart, (ii) applying the algorithm to the limited data set to form an assessment of the limited data set, (iii) retrieving a full transmission of all data stored on the medical device from the medical device, and (iv) investigating the assessment in greater detail based on the full transmission.
 5. The method of claim 1, wherein managing the limited data set includes (i) retrieving an algorithm from the data mart, (ii) applying the algorithm to the limited data set to form an assessment of the limited data set, (iii) sending verification software to the medical device, the verification software being configured to perform an additional test based on the analysis of the limited data set, (iv) receiving verification information at the data mart based on the verification software, and (v) investigating the assessment in greater detail based on the verification information.
 6. The method of claim 1, wherein managing the limited data set includes (i) retrieving an algorithm from the data mart, (ii) applying the algorithm to the limited data set to form an assessment of the limited data set, the method further comprising communicating information to a customer based on the assessment.
 7. The method of claim 1, wherein managing the limited data set includes (i) retrieving an algorithm from the data mart, (ii) retrieving historical information related to the patient and/or the medical device from the data mart, and (iii) applying the algorithm to the limited data set and the historical information.
 8. The method of claim 1, wherein managing the limited data set includes transmitting modification instructions to the medical device, the modification instructions calling for modification of (i) how the medical device monitors for and/or treats conditions, (ii) how the medical device stores medical device information, and/or (iii) time intervals at which the medical device transmits medical device information to the data mart.
 9. A non-transitory computer-readable storage medium comprising instructions for causing one or more programmable processors to: provide, by a processor, an instruction calling for medical device information that the instruction limits by at least one of: being collected by a medical device during a specific time period; or being related to a specific subject matter; receive a limited data set consisting of only medical device information that is responsive to the instruction, from medical device information stored in the medical device, the limited data set comprising at least one of: information collected during the specific time period or information related to the specific subject matter as called for by the instruction; determine whether the data mart has access to instruction information that indicates how the instruction limits the medical device information selected and transmitted by the medical device; retrieve the instruction information from the medical device in response to determining that the data mart does not have access to the instruction information; and manage the limited data set according to the instruction information based on historical information stored at the data mart.
 10. The computer-readable storage medium of claim 9, wherein the instruction (i) is provided in response to a patient episode, (ii) calls for information related to the patient episode, and (iii) asks the data mart to determine whether the patient episode was correctly identified.
 11. The computer-readable storage medium of claim 9, wherein the instruction (i) is provided in response to a detected device performance issue, (ii) calls for information related to the device performance issue, and (iii) asks the data mart to investigate the device performance issue further.
 12. The computer-readable storage medium of claim 9, wherein the instruction (i) is provided by a customer and (ii) calls for information requested by the customer.
 13. The computer-readable storage medium of claim 12, wherein the instruction further (iii) is provided according to a regular schedule and (iv) calls for information that both (a) has been collected by the medical device since a previous transmission to the customer and (b) is related to care being provided by the customer.
 14. The computer-readable storage medium of claim 9, wherein the instruction (i) is provided from a patient and (ii) calls for information related to a symptom he/she is experiencing or has recently experienced.
 15. A method of remotely caring for a patient having a medical device, the method comprising: receiving a limited data set at a data mart from a medical device, the limited data set having been selected based on an instruction calling for medical device information stored in the medical device and consisting of only medical device information that is responsive to the instruction, that the instruction limited by at least one of: being collected by the medical device during a specific time period; or being related to a specific subject matter; determining whether the data mart has access to instruction information that indicates how the instruction limits the medical device information selected and transmitted by the medical device; retrieving the instruction information from the medical device in response to the data mart determining that it does not have access to the instruction information; and managing the limited data set at the data mart according to the instruction information, wherein managing the limited data set at the data mart includes analyzing the limited data set based on historical information stored at the data mart.
 16. The method of claim 15, wherein managing the limited data set includes providing at least part of the limited data set to a separate computer for analysis.
 17. The method of claim 15, wherein managing the limited data set includes (i) retrieving an algorithm from the data mart, (ii) applying the algorithm to the limited data set to form an assessment of the limited data set.
 18. The method of claim 15, wherein managing the limited data set includes (i) retrieving an algorithm from the data mart, (ii) retrieving historical information related to the patient and/or the medical device from the data mart, and (iii) applying the algorithm to the limited data set and the historical information.
 19. The method of claim 1, wherein managing the limited data set comprises evaluating at the data mart whether a condition merits further investigation, and in response to determining that a condition merits further investigation, transmitting an instruction to the medical device calling for the medical device to increase the sensitivity of data received from a sensor of the medical device.
 20. The method of claim 5, wherein the verification software is configured to perform at least one of a clinical test on the patient to verify the assessment of the limited data set or a test to investigate a possible device performance issue.
 21. The method of claim 1, wherein the historical information comprises information related to other patients with similar characteristics or similar medical devices, and wherein analyzing the limited data set based on the historical information stored at the data mart comprises comparing the limited data set with the information related to other patients with similar characteristics or similar medical devices.
 22. The method of claim 1, further comprising providing the instruction to the medical device when remaining data storage on the medical device falls below a threshold.
 23. The method of claim 1, further comprising providing the instruction to the medical device when a variable detected by the medical device reaches a threshold.
 24. The method of claim 1, further comprising providing the instruction to the medical device when a lead connected to the medical device has worn to a threshold level.
 25. The method of claim 1, further comprising providing the instruction to the medical device when a battery on the medical device has depleted below a threshold.
 26. A method of providing for remote care of a patient with a medical device, the method comprising: receiving, by a processor of a medical device, an instruction calling for medical device information that the instruction limits by at least one of: being collected by the medical device during a specific time period; or being related to a specific subject matter; selecting a limited data set consisting of only medical device information that is responsive to the instruction, from medical device information stored in the medical device, the limited data set comprising at least one of: information collected during the specific time period or information related to the specific subject matter as called for by the instruction; transmitting the limited data set from the medical device to a data mart; receiving, by the processor of a a medical device, a request for instruction information that indicates how the instruction limits the medical device information selected and transmitted by the medical device; and providing the instruction information from the medical device to the data mart in response to the data mart determining it does not have access to the instruction information.
 27. The method of claim 26, wherein a component of the medical device provides the instruction to the medical device when remaining data storage on the medical device falls below a threshold.
 28. The method of claim 26, wherein a component of the medical device provides the instruction to the medical device when a variable detected by the medical device reaches a threshold.
 29. The method of claim 26, wherein a component of the medical device provides the instruction to the medical device when a lead connected to the medical device has worn to a threshold level.
 30. The method of claim 26, wherein a component of the medical device provides the instruction to the medical device when a battery on the medical device has depleted below a threshold. 